Provider Demographics
NPI:1194234849
Name:UNIVERSITY OF MARYLAND EYE ASSOCIATES, P.A.
Entity type:Organization
Organization Name:UNIVERSITY OF MARYLAND EYE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:KESLAR
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:IV
Authorized Official - Credentials:BA, MHSA
Authorized Official - Phone:667-214-1197
Mailing Address - Street 1:419 WEST REDWOOD, SUITE 470
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:667-214-1197
Mailing Address - Fax:
Practice Address - Street 1:5900 WATERLOO ROAD
Practice Address - Street 2:SUITE 230
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:667-214-1299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier